AccountId: 011433970860
ContactId: af54ea2d-0480-4abc-975e-41382ff41f35
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 817039 ms
Total Talk Time (AGENT): 204785 ms
Total Talk Time (CUSTOMER): 278686 ms
Interruptions: 6
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/af54ea2d-0480-4abc-975e-41382ff41f35_20250108T16:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling AT. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], how may I help you? Um, hi, [PII], this is [PII] calling from the provider's office to check on a claim status.
[AGENT][NEUTRAL] OK, Miss [PII], I can help you with the claim status. What is the patient's name, please?
[CUSTOMER][NEUTRAL] Miss [PII], I can help you with the client status. What is the patient's name please? Patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And then Miss [PII], what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Thank you and then Miss [PII], what is your callback number in case our call is disconnected? That's [PII] and it's a direct line.
[AGENT][NEUTRAL] OK, thank you very much. And then what is [PII]'s policy number?
[CUSTOMER][NEUTRAL] Alright, and then what is [PII]'s policy number? 022604887.
[AGENT][NEUTRAL] OK, let me his policy for us.
[CUSTOMER][NEUTRAL] Policy for us
[AGENT][NEUTRAL] OK, thank you and then what is the date of service for [PII]?
[CUSTOMER][NEUTRAL] Thank you and then what is the date of service for [PII]? So this is for [PII] and the bill amount is $277 even.
[AGENT][NEUTRAL] OK, thank you. And then what is the amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Thank you. And then what is the amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Mm, so actually we build the claim as primary.
[AGENT][NEUTRAL] OK, alright, and what's the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] And what's the name of the facility you're calling for? It's MEOC Community Psicians.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, Ms. [PII], while I look up that claim for you and I will be right back.
[CUSTOMER][NEUTRAL] Put you on a brief hold, Miss [PII] what I look up that claim for you and.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi Ms. [PII], this is [PII] back with you again. So looking on that day the service of [PII].
[CUSTOMER][NEUTRAL] Back with you again, so looking on that day of service of [PII].
[AGENT][NEUTRAL] I do not find a claim on file for the amount that you have given.
[CUSTOMER][NEUTRAL] I do not find a claim on file for the amount that you have to get.
[CUSTOMER][NEUTRAL] OK. So may I know the patient's eligibility?
[CUSTOMER][NEUTRAL] The date of sales.
[AGENT][POSITIVE] OK, yes ma'am, just a second, I'm putting in a note and I will make sure I get that for you.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Make sure I get that for you. OK.
[AGENT][NEUTRAL] OK, so the effective date for this policy is [PII].
[CUSTOMER][NEUTRAL] So the effective date.
[CUSTOMER][NEUTRAL] [PII] tissue.
[AGENT][NEUTRAL] And the policy is still active.
[CUSTOMER][NEUTRAL] And the policy is still active.
[CUSTOMER][POSITIVE] Thank you so much. May I know the payer ID to submit a claim?
[AGENT][NEUTRAL] Yes ma'am, the payer ID is 60801.
[CUSTOMER][NEUTRAL] The payer ID
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] And the timely filing limit is submit a claim?
[AGENT][NEGATIVE] There's not a timely filing limit.
[CUSTOMER][NEGATIVE] There's not a timely timely limit.
[CUSTOMER][NEUTRAL] OK. And also, can you please uh provide the claim's mailing address?
[AGENT][NEUTRAL] Yes ma'am, that is APL [PII].
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Our plane
[AGENT][NEUTRAL] And the [PII].
[CUSTOMER][NEUTRAL] In the [PII]
[CUSTOMER][NEUTRAL] 48
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] And the zip code is [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're very welcome Miss [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] You're very welcome
[CUSTOMER][NEUTRAL] I can help with before we go? Uh, yes, and I do have one more, uh, patient for a different provider, so can you please help me with that?
[AGENT][NEUTRAL] Absolutely. What is the patient's name?
[CUSTOMER][NEUTRAL] The patient's name. Patient name was [PII].
[AGENT][NEUTRAL] And what's [PII]'s date of birth?
[CUSTOMER][POSITIVE] Great date of birth. [PII].
[AGENT][NEUTRAL] And the policy number please?
[CUSTOMER][NEUTRAL] Number please. It is 02389384.
[AGENT][NEUTRAL] OK, let me look that up for you real quick.
[AGENT][NEUTRAL] OK, and then what is the data service for?
[CUSTOMER][NEUTRAL] And what is the data
[CUSTOMER][NEUTRAL] So this is for.
[CUSTOMER][NEUTRAL] [PII] for the amount of 300 and
[CUSTOMER][NEUTRAL] $51.60.
[AGENT][NEUTRAL] OK, and then what is the charge amount after primary paid their part?
[CUSTOMER][NEUTRAL] What is the charge
[CUSTOMER][NEUTRAL] I take their part. Um.
[CUSTOMER][NEUTRAL] So this claim is also billed as a primary.
[AGENT][NEUTRAL] OK, thank you. And then what is the name of the facility?
[CUSTOMER][NEUTRAL] The facility. It's MLC physicians.
[AGENT][NEUTRAL] OK, can you spell the first name for me please?
[CUSTOMER][NEUTRAL] Um, sure, uh, MUSC Medical University of South Carolina.
[AGENT][NEUTRAL] OK, put you on a brief hold again, Miss [PII] I mean Miss [PII], so I look up [PII]'s claim for you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claim for you. Sure.
[AGENT][NEUTRAL] I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you Ms. [PII] for holding for me. I have the claim.
[AGENT][NEUTRAL] The claim number is 353-2982.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 53
[CUSTOMER][NEUTRAL] 82
[AGENT][NEUTRAL] And the claim has been denied because we need the explanation of benefits from the primary insurance.
[CUSTOMER][NEGATIVE] denied because we need the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] May I know the claim received date and the denied date?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] We received the claim on [PII].
[CUSTOMER][NEUTRAL] need the claim on [PII].
[AGENT][NEUTRAL] And we processed it on [PII].
[CUSTOMER][NEUTRAL] And we
[CUSTOMER][NEUTRAL] Processed it on the [PII].
[CUSTOMER][NEUTRAL] So, may I know who's the primary for this patient?
[AGENT][NEUTRAL] I don't have the primary.
[CUSTOMER][NEUTRAL] I don't have the private
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is it possible to confirm, uh,
[CUSTOMER][NEUTRAL] Does the patient updated the COB?
[AGENT][NEUTRAL] Is it, I'm sorry, I don't understand the question.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I don't understand the question. So does the number updated the COB?
[AGENT][NEUTRAL] No, the EOB is sent from the primary insurance.
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] Uh, I'm asking about the COP coordination of benefits.
[AGENT][NEUTRAL] Oh, we don't have a coordination of benefits.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This is a gap insurance, so it's secondary to the primary.
[CUSTOMER][NEUTRAL] is a gap insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So then that's it for the day. Thank you so much for assisting me. May I know the reference number for the conversation?
[AGENT][NEUTRAL] Uh yes ma'am. My name is [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, is it, is it a reference number?
[AGENT][NEUTRAL] And the reference number is my name and today's date.
[CUSTOMER][NEUTRAL] Reference number is my name and today's date. OK.
[CUSTOMER][POSITIVE] Thank you so much and you may have a wonderful rest of the day bye bye.
[AGENT][POSITIVE] Bye-bye. Thank you for calling APL Ms. [PII]. You have a great rest of your day.
[CUSTOMER][NEUTRAL] And I'm sorry, I'm sorry, uh, before that, um, tour, is it possible to send a copy of EOB through my fax?
[AGENT][NEUTRAL] Yes ma'am, can I get your fax number?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and that's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I send that fax to you and I'll be right back.
[CUSTOMER][NEUTRAL] Put you on a brief hold while I send that back to you and I'll be right back OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi Miss [PII], this is [PII] back with you again. I do have that fax on its way to you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] I do have that back on its way to you. Mhm. So then that's for the [PII]. Thank you so much bye bye.
[AGENT][POSITIVE] You're welcome you have a good day. Thank you for calling APL bye bye Ms. [PII].
[CUSTOMER][POSITIVE] You too. Take care bye bye.
[AGENT][NEUTRAL] Bye